Clinical Administrative Coordinator - Miami, FL - Full-time / Part-time

Position Description:Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work. (sm) What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.Primary Responsibilities:Under the general direction of the Clinical Director or designee, provide Authorizations for Hospital Admissions, Skilled Nursing facilities, Rehabilitation facilities, Specialist Providers, Outpatient services and Ancillary services such as Home Health Care, Durable Medical equipment, Orthotics/ Prosthetic devices, Colostomy supplies and Infusion services, and others as directed.Assist in the coordination of Discharge Planning activities on all Plan participants. The Plan is dependent upon participants' Discharge needs.Communicate with a variety of Clinical disciplines to clarify and enforce Plan policies and procedures.Collect and review of service requests for completeness and referral to Clinical Director or Medical Director.Answer the telephone ACD line, as scheduled.Verify benefits in Diamond System.Referral filling and distribution to the designee coordinator.Referral processing for Outpatient services, including but not limited to Outpatient Surgeries, Rehabilitation Therapies, Radiation Therapy, Chemotherapy, Provider’s evaluations and Follow-up, Ancillary services, such as DME’s, HHC and Orthotics/Prosthetic devices.Collection of data for Clinical oversight.Pre-Authorization entering for Requests of services such as Clinical Evaluations/Follow-up visits, Outpatient procedures, Inpatient services such as: Elective Admissions, Emergency Room Admissions, Skilled Nursing facilities, Rehabilitation facilities, Outpatient services, Ancillary services, such as DME’s, HHC and Orthotics/ Prosthetic Devices in Diamond System, when applicable.Daily notification to PCP’S of Admissions Authorizations to Acute facilities. Authorization entering for Plan Members under the care of Dialysis and Hospice services.Process Denial Authorizations for non-coverage services for Medicare and Medicaid plan participant’s adherence to timeliness for determinations.                                            Maintain and update daily reports as required, including but not limited to: Daily Hospital Admission Census, Skilled Nursing Facility Census, Rehabilitation Census, Part B Census, and Home Health Care Census.Maintain monthly reports for Dialysis, Hospice, Healthy Start, Medicaid Sterilization, Abortion and Hysterectomy, Re-admission to Acute facilities, Admissions to Acute facility and Telephone ACD Reports.Assist Case Managers and PCPs in the coordination of Discharge planning from Acute Facilities to Sub-Acute placements and from Skilled Nursing facilities and Rehabilitation facilities to Home and to Community services.Maintain record of Discharge planning implemented and coordinated services.Send Discharge Notification form with all discharge planning arrangements to PCPs upon discharge from facilities.Follow up with patient to assure accuracy that the coordination of services such as HHC and DMEs has been completed.Consult with various Clinical disciplines regarding specifics patient and their follow-up needs.Identify Risk Management issues thru Health Plan guidelines and requirements and submit Incident Reports to Director.   Participate in monthly staff meetings.Participate in scheduled In-service for different disciplines.Perform Health Risk Assessment program.Ensure compliance with Risk Management policies and incident reporting.Assist with Health Risk Assessment data verification.

Requirements:High School Diploma/GED.1+ year of Healthcare or Insurance Benefits experience. 1+ year of Medical Terminology/Coding (ICD-10 and CPT) experience.6+ months of experience in an office setting using the telephone and computer as the primary instruments to perform the job.6+ months of experience in a Clerical or Administrative role.6+ months of Medicare experience. Assets:High volume Call Center experienceHospital, Physician, or Medical Clinical experienceExperience in Managed Care or Home HealthcareMedicaid experienceKnowledge or overview of Utilization Review functions Ability to interpret Medical Records and establish rapport with Clinical and Administrative staff, as well as with ProvidersCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.